血管内超声在冠脉介入治疗中的应用

随着冠心病发病率的不断增高 ,如何运用血管内超声心动图 (ＩＶＵＳ) ,协助诊断并指导介入治疗冠心病成为目前提高冠心病诊断和治疗水平的前沿课题。以往冠脉造影(ＣＡＧ)是冠心病诊断及治疗的“金标准”。但ＣＡＧ只能显示血管长轴的管腔投影影像 ,对冠状动脉病变的长度和狭窄程度的判定 ,以及确定初步治疗方案起一定作用。但对管腔的实际形态无法分辨 ,对病变位于腔内或壁内无法区别 ,无法了解血管内斑块的组织结构特性。所以ＣＡＧ对冠脉狭窄病变的直径及直径狭窄率的检测常常出现低估现象。ＩＶＵＳ可以弥补ＣＡＧ的不足 ,它对冠脉血管…     

经导管介入治疗主一肺动脉间隔缺损一例

患儿女，8岁。运动性心悸气短5年于2003年5月20日入院。体检：身高120cm，体重18．5k，血压100／50mmHg，发育较差，无紫绀和杵状指(趾)。颈静脉轻度怒张，心前区隆起，心界增大，心率110次／min，节律整齐，胸骨左缘第2～3肋间有连续性机器样杂音，心尖部有Ⅱ／Ⅵ级收缩期返流样杂音，肺动脉瓣区第二心音增强、分裂，两肺呼吸音粗糙有干湿哕音，腹软，肝大肋下3．0cm，周围血管征阳性。心电图示左心室肥厚；X线胸片示肺血多，肺动脉段突出，心胸比值为0．72；彩色多普勒超声心动图示左房左室内径增大，主动脉根部有异常血流束，二尖瓣轻度关闭不全。入院诊断为先天性心脏病左冠状动脉瘘，心功能Ⅲ级。     

心脏瓣膜闭锁二维超声心动图图像特征及规律性研究

目的： 探索心脏瓣膜闭锁（ＣＶＡ） 二维超声心动图（２ＤＥ） 图像特征及规律性。方法： １４５例ＣＶＡ年龄１～２６ （平均９．３） 岁。其中三尖瓣闭锁 （ＴＡ） ９３ 例, 室间隔缺损伴肺动脉闭锁 （ＰＡＶＳＤ） ２８ 例, 二尖瓣闭锁（ＭＡ） １７例, 室间隔完整的肺动脉瓣闭锁（ＰＡＩＶＳ） ７ 例。所有患者均有心血管造影对照, ７８ 例经手术证实。结果：２ＤＥ对１２９ 例作出正确诊断。ＣＶＡ的共同图像特征表现为闭锁的瓣膜呈一条光带状回声无开放运动。房室瓣闭锁还具有三大特征表现： １． 均有房间隔回声中断; ２．闭锁瓣膜的下方心室发育不良; ３． 闭锁瓣膜的对侧心房、心室内径显著增大。在ＣＶＡ中发病率由多到少依次为ＴＡ６４．２％ 、ＰＡＶＳＤ１９．３％ 、ＭＡ１１．７％ 和ＰＡＩＶＳ４．８％ 。结论：ＣＶＡ的２ＤＥ图像特征及规律性明显。２ＤＥ对ＣＶＡ中的ＴＡ、ＰＡＶＳＤ和ＰＡＩＶＳ具有特异性诊断价值。     

彩色多普勒超声心动图诊断冠状动脉瘘并动脉导管未闭1例

患者男,29岁.心慌气短13年,加重3个月人院.查体:体温36.5℃,脉搏100次/min,血压110/70mmHg.     

两腔心及合并畸形的彩色多普勒超声心动图特征研究

Objective To probe into the color Doppler echocardiographic characteristics of bilocular heart (BH) and associated malformations. Methods Twenty patients of BH were examined with color Doppler echocardiography (CDE) and the characteristics were observed. All the CDE results were compared with angiocardiography and 14 were confirmed by operation. Results Nineteen cases were properly diagnosed based on the CDE characteristics,1 case were misdiagnosed as mitral atresia. CDE characteristics of BH were obvious:① Apical four-chamber view of two-dimensional echocardiography (2DE) showed total echo dropout in both the interatrial septum and the interventricular septum and disappearance of the intracardiac "cross". The common atrioventricular valve closed during systole and appeared as figure "8", named 2DE "8" sign. During diastole, the common atrioventricular valve opened to a common ventricle. ② Color Doppler flow imaging (CDFI) showed common intra-atrial flow signal entereda common ventricle through common atrioventricular valve during diastole in all patients and colorful reflux through common atrioventricular valve during systole in 15 cases. ③ Among the 20 eases, 16 of the common atria were situs solitus,4 were situs inversus; 10 of the common ventricles were type A,2 were type B and 8 were type C. According to the spatial relationship of the great arteries,there were 4 type Ⅰ ,7 type Ⅱ and 9 type Ⅲ.There were 18 pulmonary stenosis and 2 pulmonary hypertension. ④ In the presence of pulmonary stenosis, CDFI showed colorful shunt signals through pulmonary artery during systole. Conclusions BH and associated malformations have obvious echocardiographic characteristics. CDE has a specific value in diagnosing BH and associated malformations.     

超声心动图导引下介入治疗室间隔缺损

目的研究体表超声(TTE)导引介入治疗室间隔缺损(VSD)的临床意义.方法 57例膜部 VSD,18例合并膜部室间隔膨出瘤;5例肌部VSD,其中1例为多发性,1例为心肌梗死所致室间隔穿孔,1例合并膜部室缺.缺损直径2～16 mm.在TTE引导下,采用4～18 mm封堵伞进行经导管介入封堵.结果 TTE明确诊断62例VSD,准确率100%.61 例VSD介入治疗成功,成功率98.4%.术后51例左向右分流束消失,10例残余少量左向右分流,其中6例合并主动脉瓣轻度关闭不全,4例合并轻度二、三尖瓣关闭不全.结论 TTE导引在VSD封堵术中确定适应证,预防并发症必不可少.     

彩色多普勒超声心动图诊断心肌梗死后心室间隔穿孔一例

彩色多普勒超声心动图诊断心肌梗死后心室间隔穿孔一例侯传举刘剑立邓东安徐春华苏虹张玉威⒇我们应用彩色多普勒超声心动图（ＣＤＥ）诊断１例心肌梗死后心室间隔穿孔，现报告如下。１临床资料患者男性，７６岁。反复发作心前区疼痛７年。血压１６．０／１０．７ｋＰａ（...     

彩色多普勒超声心动图在老年房间隔缺损封堵术中的价值

目的探讨彩色多普勒超声心动图(CDE)在老年房间隔缺损(ASD)封堵术中的价值。方法选择老年ASD患者64例,封堵术前应用二维超声心动图观察ASD位置,测量ASD大小和残余边缘,彩色多普勒血流显像观察过房间隔分流束血流信号和过心脏瓣膜反流束血流信号,连续多普勒估测肺动脉压,合并心房颤动和多发ASD经食管超声心动图检查,筛选ASD封堵术适应证。ASD封堵术中应用二维超声心动图监视封堵器位置,用彩色多普勒血流显像监视有无过房间隔残余分流。ASD封堵术后应用CDE判断疗效。结果 64例老年ASD患者实施ASD封堵术全部获得成功,ASD封堵术后CDE判断疗效满意。结论 CDE在老年ASD封堵术中有重要价值。ASD封堵术前应用二维超声心动图观察ASD位置、大小和残余边缘,连续多普勒估测肺动脉压,合并心房颤动和多发ASD行经食管超声心动图检查是筛选老年ASD封堵术适应证的关键。